I spent some time over the weekend reading the News – because – well, that is what my people do. We read stuff to stay informed.
ANESTHESIA STAFF
The first article I read was sent to me by my law partner Bo, and was about a Bill sitting on Gov. Youngkin’s desk that would allow less trained professionals to serve in Virginia operating rooms as part of the Anesthesia team going forward in Virginia.
The article discusses how 20 other states allow CAAs to practice, but Virginia currently does not.
Let’s peel back the veil on why hospital systems might like this change.
Well, money. Dollar Dollar Bills Ya’ll!
If you can bill a midlevel (CAA or CRNA) out at 50% to 75% of what you can bill an MD out, but pay the mid-level 25% of what you pay the MD – you the hospital, makes money.
Real Talk. MD makes $450,000 + a year. CAA makes about $125,000. Procedure bills are the same.
Let’s also peel the veil back on why we as patients, consumers of healthcare may notwant this change in the law.
Let’s start by defining the terms, and looking at the education and training of the providers at issue.
Anesthesiologist Training includes
Undergraduate education: 4 years (Bachelor’s degree)
Medical school: 4 years (MD or DO)
Anesthesiology residency: 4 years After completing medical school, an aspiring anesthesiologist enters a residency program in anesthesiology that typically lasts 4 years. Additional fellowships are available (e.g., in pain management, pediatric anesthesia, etc.), which can add another 1–2 years.
Total years of training: 12–14 years (Bachelor’s, Medical School, and Residency)
Testing Criteria: USMLE (United States Medical Licensing Examination): Step 1 (basic sciences) Step 2 (clinical knowledge and skills) Step 3 (assesses a physician’s ability to provide unsupervised patient care); and Board Certification in Anesthesiology: After residency, anesthesiologists must pass the American Board of Anesthesiology (ABA) written exam and oral exam to become board-certified.
CRNA (Certified Registered Nurse Anesthetist) Training:
Bachelor’s degree in Nursing (BSN): 4 years
Registered Nurse (RN) experience: Typically 1–2 years in critical care (ICU) or a similar high-acuity area before applying to CRNA programs
Master’s or Doctoral degree in Nurse Anesthesia: 2–4 years CRNA programs are offered at the master’s or doctoral level, and they focus on advanced nursing practice and anesthesiology. Most CRNA programs are now Doctor of Nurse Anesthesia Practice (DNAP) programs, requiring 3–4 years of study.
Total years of training: 7–10 years (BSN, RN experience, and CRNA program)
Testing Criteria: National Certification Examination: After completing the CRNA program, candidates must pass the National Certification Examination (NCE) administered by the National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA). Recertification: CRNAs must complete continuing education and take a national recertification exam every 8 years.
CAA (Certified Anesthesiologist Assistant) Training:
Bachelor’s degree: 4 years
Anesthesiologist Assistant Master’s program:2–3 years CAA programs typically involve 2–3 years of graduate education that focuses on anesthesiology, pharmacology, physiology, and clinical anesthesia practices.
Total years of training: 6–7 years (Bachelor’s and CAA Master’s program)
Testing Criteria: Certification Exam: After completing the master’s program, CAAs must pass the Certification Examination for Anesthesiologist Assistants (CEEAA) administered by the National Commission for Certification of Anesthesiologist Assistants (NCCAA).
Recertification: CAAs must take the Certification Maintenance Program (CMP) and recertify every 6 years.
Key Differences:
- MD Anesthesiologists require the longest training period, typically 12–14 years.
- CRN
As have a different starting point with nursing education, and their total training is 7–10 years. - CAAshave only 6-7 years of training.
Bottom line, with this law, healthcare providers (hospitals, groups, insurance companies) make more money – and We the People, get less trained providers.
Well Lauren you may be thinking, that doesn’t mean the care changes? Does it?
Well, let me explain how it very well might.
In 20 years, I haven’t sued a single Internal Medicine MD. Not one. Why? Because we don’t get calls of internal medicine doctors making huge mistakes that are deemed malpractice. I haven’t sued a single Anesthesiologist either. We just don’t get calls for people getting injured by the men or women controlling the anesthesia. But in the last 10 years, we are getting MANY MANY calls about PAs and NPs in internal medicine who are making mistakes and missing things. So in my limited experience, and in my limited opinion – better training usually means better care. LESS training, LESS RIGOROUS training means we will likely see a decline in the care we receive. Is it a guarantee, no. But is it likely? I am fearful it is.
Here’s another heartbreaking example of profits over people.
NURSING HOMES
In Virginia Business this Month, there is a report on which Virginia Nursing Homes self reported over $18,000,000 in NET PROFIT. Not chains. Buildings. Given that most NH residents are not private pay and their bill is capped by Medicare and Medicaid, you may be surprised to know that a for profit facility in little old Salem Virginia with 240 beds, made over $18,000,000 in profits last year. Pretty good investment there.
Well golly, gee, how did they do it?
Well, by not 
hiring the number of nurses and CNAs that Medicare suggested they hire and, or paying the ones they do have enough.
Medicare sets staffing levels based on patient acuity, or needs. The facility knows these needs, but rarely hires more or pays more to keep better help. https://www.medicare.gov/care-compare/details/nursing-home/495087?city=Salem&state=VA&zipcode=&measure=nursing-home-staffing
The facility that netted $18,000,000 – got a 1 star out of 5 stars on STAFFING. Medicare goes on to say the residents in that facility got 42 minutes less a day of care than Virginia’s average, and 50 minutes less a day of care that National average for a SUM TOTAL of just over 3 hours a day of care, out of 24. That includes every CNA, every LPN, every physical therapist – add them all up and on average, patients are getting NO CARE for 21 hours a day. On the weekends, it was even bleaker – patients received on average only 2 hours at 26 minutes of care a day, under both the National average of 3 hours and 23 minutes and Virginia average: 3 hours and 14 minutes.
Well gee wiz, no wonder they were so profitable. They weren’t providing the nurses that Medicare said they should to provide for the patients and by understaffing, they got to keep the money they received from Medicare.
Now Lauren, you biased plaintiff’s attorney – that doesn’t mean that people were getting hurt by these cost saving measures, does it?
Well, the facility was also ranked only two stars out of five by Medicare for overall ranking (including quality measures and inspections) AND Medicare themselves says that Higher staffing levels and lower staffing turnover in a nursing home may mean higher quality of care for residents. So, Medicare seems worried they didn’t get good adequate care. Maybe we should be too.
I am all for profits, but not at the expense of people’s lives. At some point Americans need to chose what is more important. Our health, and our lives, or the almighty dollar.